Cardiac Resynchronization Therapy and QRS Duration: Systematic Review, Meta-analysis, and Meta-regression

Cardiac Resynchronization Therapy and QRS Duration: Systematic Review, Meta-analysis, and Meta-regression

Cardiac resynchronization therapy (CRT) has been shown to reduce the risk of death and hospitalization in patients with advanced heart failure with left ventricular dysfunction. However, controversy remains regarding who would most benefit from CRT. We performed a meta-analysis, and meta-regression...

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Main Authors: Kang, Si-Hyuck, Oh, Il-Young, Kang, Do-Yoon, Cha, Myung-Jin, Cho, Youngjin, Choi, Eue-Keun, Hahn, Seokyung, Oh, Seil
Format: Online
Language:English
Published: The Korean Academy of Medical Sciences 2015
Online Access:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4278024/
id pubmed-4278024
recordtype oai_dc
spelling pubmed-42780242015-01-01 Cardiac Resynchronization Therapy and QRS Duration: Systematic Review, Meta-analysis, and Meta-regression Kang, Si-Hyuck Oh, Il-Young Kang, Do-Yoon Cha, Myung-Jin Cho, Youngjin Choi, Eue-Keun Hahn, Seokyung Oh, Seil Original Article Cardiac resynchronization therapy (CRT) has been shown to reduce the risk of death and hospitalization in patients with advanced heart failure with left ventricular dysfunction. However, controversy remains regarding who would most benefit from CRT. We performed a meta-analysis, and meta-regression in an attempt to identify factors that determine the outcome after CRT. A total of 23 trials comprising 10,103 patients were selected for this meta-analysis. Our analysis revealed that CRT significantly reduced the risk of all-cause mortality and hospitalization for heart failure compared to control treatment. The odds ratio (OR) of all-cause death had a linear relationship with mean QRS duration (P=0.009). The benefit in survival was confined to patients with a QRS duration ≥145 ms (OR, 0.86; 95% CI, 0.74-0.99), while no benefit was shown among patients with a QRS duration of 130 ms (OR, 1.00; 95% CI, 0.80-1.25) or less. Hospitalization for heart failure was shown to be significantly reduced in patients with a QRS duration ≥127 ms (OR, 0.77; 95% CI, 0.60-0.98). This meta-regression analysis implies that patients with a QRS duration ≥150 ms would most benefit from CRT, and in those with a QRS duration <130 ms CRT implantation may be potentially harmful. The Korean Academy of Medical Sciences 2015-01 2014-12-23 /pmc/articles/PMC4278024/ /pubmed/25552880 http://dx.doi.org/10.3346/jkms.2015.30.1.24 Text en © 2015 The Korean Academy of Medical Sciences. http://creativecommons.org/licenses/by-nc/4.0/ This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
repository_type Open Access Journal
institution_category Foreign Institution
institution US National Center for Biotechnology Information
building NCBI PubMed
collection Online Access
language English
format Online
author Kang, Si-Hyuck
Oh, Il-Young
Kang, Do-Yoon
Cha, Myung-Jin
Cho, Youngjin
Choi, Eue-Keun
Hahn, Seokyung
Oh, Seil
spellingShingle Kang, Si-Hyuck
Oh, Il-Young
Kang, Do-Yoon
Cha, Myung-Jin
Cho, Youngjin
Choi, Eue-Keun
Hahn, Seokyung
Oh, Seil
Cardiac Resynchronization Therapy and QRS Duration: Systematic Review, Meta-analysis, and Meta-regression
author_facet Kang, Si-Hyuck
Oh, Il-Young
Kang, Do-Yoon
Cha, Myung-Jin
Cho, Youngjin
Choi, Eue-Keun
Hahn, Seokyung
Oh, Seil
author_sort Kang, Si-Hyuck
title Cardiac Resynchronization Therapy and QRS Duration: Systematic Review, Meta-analysis, and Meta-regression
title_short Cardiac Resynchronization Therapy and QRS Duration: Systematic Review, Meta-analysis, and Meta-regression
title_full Cardiac Resynchronization Therapy and QRS Duration: Systematic Review, Meta-analysis, and Meta-regression
title_fullStr Cardiac Resynchronization Therapy and QRS Duration: Systematic Review, Meta-analysis, and Meta-regression
title_full_unstemmed Cardiac Resynchronization Therapy and QRS Duration: Systematic Review, Meta-analysis, and Meta-regression
title_sort cardiac resynchronization therapy and qrs duration: systematic review, meta-analysis, and meta-regression
description Cardiac resynchronization therapy (CRT) has been shown to reduce the risk of death and hospitalization in patients with advanced heart failure with left ventricular dysfunction. However, controversy remains regarding who would most benefit from CRT. We performed a meta-analysis, and meta-regression in an attempt to identify factors that determine the outcome after CRT. A total of 23 trials comprising 10,103 patients were selected for this meta-analysis. Our analysis revealed that CRT significantly reduced the risk of all-cause mortality and hospitalization for heart failure compared to control treatment. The odds ratio (OR) of all-cause death had a linear relationship with mean QRS duration (P=0.009). The benefit in survival was confined to patients with a QRS duration ≥145 ms (OR, 0.86; 95% CI, 0.74-0.99), while no benefit was shown among patients with a QRS duration of 130 ms (OR, 1.00; 95% CI, 0.80-1.25) or less. Hospitalization for heart failure was shown to be significantly reduced in patients with a QRS duration ≥127 ms (OR, 0.77; 95% CI, 0.60-0.98). This meta-regression analysis implies that patients with a QRS duration ≥150 ms would most benefit from CRT, and in those with a QRS duration <130 ms CRT implantation may be potentially harmful.
publisher The Korean Academy of Medical Sciences
publishDate 2015
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4278024/
_version_ 1613171103603097600

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